Caregiver Emotions When Choosing A Living Environment for A Person with Dementia: A Qualitative Study on Social Workers' Perspectives.

Social workers often address the emotional needs of family caregivers, which are particularly salient during the decision-making process regarding the choice of a living environment for a relative with dementia. In most home care settings, an assessment of caregivers' needs is not part of routine practices. This study aims to describe the intervention strategies adopted by social workers in relation to caregivers' emotions during their decision-making process. A qualitative research design was adopted. Seven social workers were recruited from three health and community service facilities in Montreal, Canada. One group and three individual semi-structured interviews were conducted. Data was analyzed using Miles, Huberman and Saldaña's method (2013). Seven intervention strategies were identified: investigating emotions, acknowledging emotions, encouraging caregivers to carry on their role, focusing on the rational aspects of the decision, mitigating prejudices against nursing homes, mediating family dynamics and acting upon families' needs. Some of these strategies are aimed at social workers meeting the demands of their jobs whilst others are centered around soothing caregiver emotions. These results can inform support services and future interventions by grounding them in the realities of service providers.

[Infants' attachment security in a vulnerable French sample]. / Sécurité de l'attachement des jeunes enfants dans une population française vulnérable.

INTRODUCTION: Attachment is a long lasting emotional link established between infants and their caregivers. The quality of early relationships allows infants to safely explore their environment and contribute to the establishment of a broad range of social skills. Several intervention programs targeting infant attachment have been implemented in different contexts, showing diverse degrees of efficacy. OBJECTIVE: The present paper describes, for the first time, children's attachment quality distributions in a French multi-risk population, with a preventive intervention, usual or reinforced. METHOD: In the CAPEDP study (Parenting and Attachment in Early Childhood: reducing mental health disorder risks and promoting resilience), a sub-sample of 117 women was recruited to assess the effects of this home-visiting program on children's attachment security. With that intent, the Strange Situation Paradigm was used when infants were between 12 and 16 months of age. RESULTS: In the intervention group, 63% (n=41) of the infants were coded as secure, while 15% (n=10) of them were coded as insecure-avoidant and 22% (n=14) as insecure-ambivalent/resistant. 56% (n=29) of control group infants (usual care) were coded as secure, while 27% (n=14) were coded as insecure-avoidant and 17% (n=9) as insecure-ambivalent/resistant. Even if the percentage of children with a secure attachment in the reinforced intervention group was higher than that of the control group, this difference did not reach the threshold of significance [Chi2 (2)=2.40, P=0.30]. DISCUSSION: Intervention group distributions were closer to normative samples, and these distributions show the clinical impact of our program. In general, preventive interventions focused on attachment quality have moderate effects but, in our case, several factors might have contributed to lower the statistical impact of the program. Firstly, the control group cannot be considered has having received zero intervention for two reasons: (a) the French usual perinatal health system (Maternal and Infant Protection System) is particularly generous and (b) the effect of this usual system might have been increased by the project intensive assessment protocol (6 visits during 28 months). Secondly, it is possible that the full effect of the intervention had not yet been detected because, when a child's attachment was assessed, only two thirds of the intervention visits had been performed (29 of 44 visits). A "sleeper effect" is still possible: we hope that a more clear result will be seen when children are assessed again, at 48 months, in our follow-up study (CAPEDP-A II). By clarifying the mechanisms involved in the development of a secure attachment, our study aims to contribute and refine the development of early preventive intervention strategies in high perinatal and psychosocial vulnerability contexts.

[Promoting family-professional partnership in institutions for children with autism]. / Promouvoir le partenariat parents-professionnels dans la prise en charge des enfants atteints d'autisme.

OBJECTIVE: The present study aims to evaluate the impact of the Family-Professional Partnership Model on parents' perception of being enabled and empowered in the treatment of their autistic children. In the context of treatment for children with autism, the Family-Professional Partnership Model strives to create an egalitarian relationship between parents and mental health professionals and it encourages parents to actively participate in their child's treatment. To evaluate the effectiveness of the Family-Professional Partnership Model at enabling and empowering parents of autistic children at the IME, parents of autistic children (n=18) completed the EPS and the PES. METHOD: For the purposes of this study, the EPS and the PES were translated into French. Eighteen parent couples of autistic children (ages 4-13 years) receiving treatment at the IME for 1 to 2 years agreed to participate. Participants' responses to the EPS were correlated with their responses to the PES. RESULTS: Parent scores on the EPS significantly correlated with their scores on the PES. Father scores on the two measurements correlated significantly, whereas the correlation between mother scores on these measurements remained insignificant. CONCLUSION: The findings of this study are limited by the small sample size (n=18) but they suggest that the Family-Professional Partnership Model had a positive impact on parent enablement and empowerment in taking care of their autistic children. Future studies should evaluate enablement and empowerment in a larger sample of subjects. They should also evaluate specific factors in the Family-Professional Partnership that lead to parent empowerment.

[Mental health disorders, medical care and social support in a vulnerable population: the example of the maternal centres in Paris]. / Troubles de santé mentale, recours aux soins et au soutien social chez une population vulnérable : l'exemple des centres maternels de Paris.

INTRODUCTION: The negative effect of social deprivation and poverty on mental health has been the subject of numerous publications since the 1960s, with studies generally showing a higher prevalence of mental health disorders in homeless, unemployed or low income populations. Women in perinatal contexts are also at greater risk for psychopathology: the relative risk for being hospitalised is up to 60% higher in the perinatal period than during the two years preceding pregnancy. Access to social care and informal support is therefore particularly important for pregnant women in vulnerable social conditions. In France, socially excluded mothers access shelter and accommodation in maternal centres. Over the last few years, staff in these centers report what they perceive to be as an increase in the prevalence of mental health problems in the mothers using these services. The current study, CEMAT, set out to examine this question. METHODOLOGY: Based on a participatory research method, a qualitative and epidemiological study was carried out in order to evaluate the reality and needs in terms of mental health care in this population, as well as to evaluate available care and support networks. The study took place in 2005. All stakeholder groups in six maternal centres agreed to participate in focus groups and, in addition, residents were invited to respond to epidemiological and qualitative questionnaires, including the Mini International Neuropsychiatric Interview (MINI 5.0.0) and its qualitative questions aimed at evaluating use of medical and social network resources. Overall, 95 women took part in this study, representing 61% of all residents. Subjects were young (64% under 26) and 57% had been living in their centre for over 12 months. RESULTS: A percentage of 68% (N=65) of the participants were identified as having a mental health disorder, according to the MINI. Of these 65 women, 55 (85%) had consulted a physician (mainly general practitioners and gynecologists) during the preceding two months. Ninety seven per cent of women validating one or more MINI diagnoses had specifically looked for help for these disorders, 17% seeking only professional help (GP, psychiatrist, psychologist, social worker, expert in non conventional medicine or traditional care), 23%looking for an informal source of support (partner, family, friends) and 57% using both professional care and informal support. High rates of satisfaction (69% for professional services, 81% for informal support) showed the capacity of this population to request relevant social and medico-social support. DISCUSSION: Results tend to confirm the links between psychosocial vulnerability and mental health disorders. On the other hand, the women's ability to ask for and to access specific psychological care, whether it be from professionals or informally from friends and family is to be underlined. The high satisfaction rates tend to prove that, though psychologically vulnerable, this population has coping capacities that should be recognized and valorized. Options open to such structures do not necessarily involve the sole development of internal mental health resources, but need to acknowledge and strengthen existing support networks.

[Paradoxical aggressive reactions to benzodiazepine use: a review]. / Réactions d'agressivité sous benzodiazépines: une revue de la littérature.

INTRODUCTION: With growing prescription and availability, benzodiazepine usage in France is on the increase among the general population. Although its anxiolytic action has long been proven, many side effects can be observed. TYPOLOGY AND PREVALENCE: Paradoxical reactions of aggressiveness under benzodiazepines have been discussed in the scientific literature since the 1960s. This term was introduced to describe reactions of agitation and disinhibition occurring during anxiolytic or hypnotic treatment. Physical aggression, rape, impulsive decision-making and violence have been reported, as well as autoaggressiveness and suicide. General population studies indicate a prevalence of these reactions of less than 1%, and meta-analysis has shown that use of benzodiazepines generates aggressiveness more frequently than it reduces it. It has also been shown that long-term memory (anterograde amnesia) can be impaired following the ingestion of a benzodiazepine. RISK FACTORS: Benzodiazepine-linked disinhibition, auto and heteroaggressiveness, anxiety and criminal acts have been associated with various vulnerability factors. Although the risk of these paradoxical reactions depends on the number of such factors present in a single patient, the effects of the type and dose of benzodiazepine on the frequency and the intensity of paradoxical symptoms are not clear. In terms of personality, several studies have demonstrated the role of low-stress control (specifically high-trait anxiety) on aggressiveness under benzodiazepines. Other authors underline the role of borderline personality disorder as a major risk factor predicting paradoxical reactions. Results of a study on borderline patients show a prevalence of benzodiazepine-linked disinhibition of 58%. On a neuropharmacological level, the influence of the GABA system on the serotonin control and the impact of alcohol seem to be established. Benzodiazepines, specifically when associated with alcohol, seem to facilitate GABAergic transmission, which can be at the origin of the disinhibited behaviours that have been reported. DISCUSSION: In 2000, France was the first country in terms of benzodiazepine use 17.4% of the adult population had been prescribed an anxiolytic. Implications for medicolegal and clinical practice are discussed.